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IRACH no longer accepting inpatient medical care, surgical patients

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By RACHAEL TOLLIVER

As Fort Knox’s Ireland Army Community Hospital starts its transition into a clinic as part of Army restructuring, patients will see some changes. For example, as of Monday the hospital, the oldest in the Army’s inventory, will no longer accept inpatient medical care or surgical patients, except for those already being seen in obstetrics.

In the past the hospital admitted patients for procedures such as joint surgeries, cardiac monitoring, bariatrics, hysterectomies and patients from the emergency room who needed IV antibiotics, fluid rehydration and monitoring.

But according to Lt. Col. Jana Nohrenberg, deputy commander for surgical service at IRACH, they no longer have the doctors and nurses on staff to continue safe quality service.

“In the past we have done (for example) joint surgeries, cardiac monitoring—but as this decision to become a clinic became more concrete MEDCOM (Medical Command) stopped assigning surgeons to the hospital,” she explained. “Ireland has a phenomenal track record for safety. By that I mean we don’t have …events in which we have caused inadvertent harm to patients.

“And we historically have a very low post-operative infection or complication rate. It’s important to us to maintain that standard for our patients. They deserve no less.”

According to Nohrenberg, the IRACH staff considers quality and safe care to be something that exceeds a normal standard. It doesn’t put patients at risk to inadvertent injury due to medication errors, inappropriate surgical procedures, slips-trips-falls and avoids the “failure to rescue” circumstance. Failure to rescue is where a patient is deteriorating and no one catches it—the condition goes unnoticed—and she said they go to great lengths to avoid that situation.

But with a lack of staff, she said the quality of patient care could not be guaranteed.

“We use minimum safe staffing standards to drive a lot of these decisions,” she added. “On the medical surgical ward that minimum safe staffing standard is two licensed nurses for every shift. Which means you really need to have a core staff of 12. We are down to nine nurses.

“We could still cover those shifts for a period of time, but that means everyone has to come to work, which isn’t realistic. People need vacation time, people get sick—things happen. As we lose those highly qualified and competent nurses we can’t continue to provide the same level of safe and quality care and that is what is driving the decision for the timeline.”

Patients who will require specialty care, for example those with abdominal pain; hernias; surgical orthopedic care; GYN surgery; ophthalmology and ENT will be referred to a civilian provider.

Providers that partner with Ireland and who can offer the same level of quality care include Norton’s, Jewish, UofL, Baptist, Flaget and Hardin Memorial Health. For example at HMH Dennis Johnson, who is the president and chief executive officer at HMH, said his organization has been working with IRACH for a long time and he notes the seamless partnership.

“Hardin Memorial Health has a long-standing partnership with Fort Knox and Ireland Army Community Hospital,” he explained. “We have collaborated closely for decades. HMH is working closely with Ireland leadership to ensure a smooth transition for their patients who will need to seek health care services off post.”

But Nohrenberg said the exception to IRACH inpatient admittance is obstetrics because the OB staff is stable and the hospital feels it can continue the safe quality care patients are currently getting.

“Those patients who are already in the system will be seen— we stopped enrolling new OB patients March 1,” Nohrenberg noted. “The last mom we have on our books is due Nov. 1—the nice thing about OB patients is that they are sort of predictable. So we picked the March 1 date to stop enrolling because our (MEDCOM) required date to suspend services is Dec. 15 (and with the due date of Nov. 1) that would give us the six weeks for follow-up care to the new mothers. That is why we picked these dates for OB.”

She said the only thing different that patients will notice at doctors’ offices and hospitals in the civilian sector are the uniforms.

“They won’t see (ACUs) on the staff, and some of terminology for something like ‘billing’ might be different,” she said. “But otherwise, they will get the same safe quality care. We have great partners.”

And she isn’t just saying that. Nohrenberg will have a baby in the next few weeks—not at Ireland but at Norton’s Hospital in Louisville.

“For my own personal medical care I will be having my C-section at Norton’s in Louisville,” she explained. “I trust our partners where I was referred, and the reason I am going there instead of having it here at Ireland is because I need a more advance level of monitoring and I need services that are not provided at Ireland given my age and personal history.”

Nohrenberg said she knows people will have questions about their specific situations and there are resources available to answer all those questions. For example, a question about how a surgical referral works, who a patient would see and how the process functions can be answered by Tricare at (877) TRICARE (874-2273). And for the newcomer to the military medical system, Tricare is also the primary resource to explain how it all works.

There is also a referral management office patients can call at (502) 624-0713 that can help with surgical referrals once Tricare has established contact with a provider. And if a patient feels they are not getting the service they need or are having problems with care they are encouraged to call the Patient Advocate Office at (502) 624-9211.

Lt. Col. Rebecca Terry, the deputy commander at IRACH, said the bottom line for hospital staff is the patients, their welfare and their safety.

“Our patients’ primary care providers will continue to be the coordinators for their health care and will continue look out for their well-being,” she said. “Ireland has a long history in Kentucky, and a great record of looking out for the welfare of this community. We intend on continuing that record—our patients deserve that.” n